Jordan Axelrad, MD, MPH

Jordan E. Axelrad, MD, MPH, treats patients with Crohn's disease and ulcerative colitis while managing Crohn's disease himself—an experience he says gives patients real comfort as they face major, long-term treatment decisions. 

In an interview with HCPLive, the co-director of NYU Langone's Inflammatory Bowel Disease Center discussed how he approaches first-line therapy selection, the role of treat-to-target in day-to-day management, and how that personal experience shapes the way he counsels patients.

For a deeper dive on drug selection and sequencing, read 

Optimizing IBD Treatment and Sequencing, With Jordan Axelrad, MD, MPH

Q&A: How a Physician With Crohn's Disease Approaches IBD Care

HCPLive: With so many mechanisms of action now available for Crohn's and ulcerative colitis, how are you approaching first-line therapy selection and sequencing after failure, and what factors most influence that decision?

The first thing I'm always doing when I meet with a patient is assessing disease activity, so their snapshot of what's going on right now, and disease severity—what's their risk of disease progression and disease prognosis over time. That's a bit more relevant for Crohn's disease, but certainly is relevant for ulcerative colitis as well. Then I'm also having shared decision-making with the patient, understanding what's important to the patient, whether patients can achieve an infusion medication, whether they will be able to take an injectable medication, or whether they only want to take an oral medication. All of that's going to influence the decision-making that we'll make together.

Once we sort of meet in the middle of what's important to the patient and how severe and active their disease is, which also influences drug selection, then we make a decision together. Typically, after patients fail an initial therapy—and of course you want to be making sure that objectively you're assessing for failure with objective biomarkers or endoscopy—then typically we use medications that have evidence in a second or third-line use. In today's world, those medications are primarily anti-TNF agents and JAK inhibitors. That's usually what we'll use after patients have a primary therapeutic failure to an alternative agent, but that activity and severity is really important for assessing what patients will need.

HCPLive: How has the treat-to-target approach changed your day-to-day management of IBD patients? What combination of clinical, biomarker, and endoscopic data do you rely on to confirm a patient is truly in remission?

I have the treat-to-target conversation with all of my patients so that my patients and I are on exactly the same page when we're discussing therapy initiation. I meet them exactly where they are—I expect them to start feeling better within a couple of weeks to months, I expect their biomarkers to improve within a couple of weeks to months, and then I expect long-term improvement in their endoscopic appearance, or radiographic appearance in Crohn's disease, over time, and that may be a longer-term treatment target. I'm having that conversation with patients so they can understand exactly the expectations of when they may start feeling better, and also what I'm looking for to confirm objectively that patients are doing better.

Those assessments may actually vary from patient to patient, but generally we want to see meaningful improvements in endoscopic response within 6 months to 1 year, and we're adjusting treatment based on treat-to-target if we're not achieving those important goals. Everyone's a little bit different, so there may be instances where patients have no response to an individual therapy, in which case we may switch to a completely different mechanism, whereas many patients may have partial response and we may work toward optimizing that therapy to meet our treat-to-target goals.

HCPLive: As new IBD therapies continue to reach approval, how do you decide where a new drug fits relative to established options, and what unmet needs are you still looking for these therapies to address?

We still have a huge amount of unmet need in inflammatory bowel disease. Meaningful disease remission, as far as endoscopic remission, is difficult to achieve with our current therapeutic arsenal. Additionally, there are many subtypes of Crohn's disease, for example, fistulizing Crohn's and stricturing Crohn's, where medications work far less well compared to other types of Crohn's and ulcerative colitis, so there's a huge amount of therapeutic unmet need.

Anytime a new medication comes to market, you always want to know what's the value of this new medication. Is it a route of administration? Is it safety? Is it efficacy? Does it work in unique subtypes? Where is that value? That's how I make decisions about integrating new therapies into my treatments. If a new drug that comes to market works particularly well in patients who have failed other therapies, that's a great addition, because these are patients who have even more unmet need, and that's really important in evaluating drugs as they come to market. Despite all that, there's still a huge amount of unmet need, and we're still desperately searching for new therapies, or maybe combinations of therapies, that move the needle toward a greater proportion of patients achieving meaningful disease outcomes.

For more on separating symptoms from true disease activity, read 

When IBD Symptoms Don't Match Inflammation, With Jordan Axelrad, MD, MPH

HCPLive: IBD symptoms can overlap with strictures, infection, and other complications. What's your clinical approach to working up a patient who isn't responding as expected before assuming it's simply active disease?

Symptoms do not always correlate with objective inflammatory activity, and that's really important to why patients and providers have to be on the same page about the workup required anytime someone is symptomatic. Often, patients will reach out to me saying, I'm not feeling well, I'm having acute symptoms, I need prednisone or what have you. It's important that patients understand that symptoms not correlating with disease activity means we need to check objective markers.

That may require laboratories and biomarkers, including C-reactive protein and fecal calprotectin. It may require endoscopy to more objectively assess the status of the mucosa, and in patients with Crohn's disease, may often require cross-sectional radiography or intestinal ultrasound. Having these objective markers of inflammatory activity helps us differentiate symptom exacerbation or an infectious etiology from a flare of underlying IBD, because all of those are going to be managed very differently.

HCPLive: As someone living with Crohn's yourself, how has that personal experience shaped the way you counsel patients through diagnosis, treatment decisions, and the long-term realities of managing IBD?

I think patients find comfort in recognizing that I'm someone who's also used the medications that I'm talking about with patients. Keeping in mind that IBD is a disease that affects younger people, moving to a medication that may be infusion or injectable, and that is long-term, is a major step and a major modification to many patients' lives. Having that comfort with patients, knowing that I've been through that process and understand what it's like, can be really, very helpful.

Patients oftentimes don't come to the office asking how quickly they can feel better. They're usually much more concerned about the side effect profile and the long-term interruption of these medications in their lives. Having that personal experience really gives patients calm and more confidence in making these decisions together when it comes to medication selection.

Editor’s Note: Axelrad reports relevant disclosures with AbbVie, Abivax, Adiso, BioFire Diagnostics, bioMérieux, Bristol Myers Squibb, and others.

Turner D, Ricciuto A, Lewis A, et al. STRIDE-II: an update on the Selecting Therapeutic Targets in Inflammatory Bowel Disease (STRIDE) initiative of the International Organization for the Study of IBD (IOIBD): determining therapeutic goals for treat-to-target strategies in IBD. 

Lichtenstein GR, Loftus EV Jr, Isaacs KL, Regueiro MD, Gerson LB, Sands BE. ACG clinical guideline: management of Crohn's disease in adults. 

Articles

Therapeutic selection in IBD is framed by contemporaneous disease activity, projected severity/risk of progression, and shared decision-making around route of administration and patient preferences. Objective confirmation of treatment failure is emphasized before sequencing, with anti-TNF agents and JAK inhibitors commonly used in later lines after primary failure. Treat-to-target expectations are set upfront, spanning symptomatic improvement, biomarker normalization, and longer-horizon endoscopic or radiographic healing. Persistent unmet needs include achieving endoscopic remission and improving outcomes in fistulizing and stricturing Crohn’s disease.

Jordan E. Axelrad, MD, MPH, on selecting first-line IBD therapy, treat-to-target monitoring, and how living with Crohn's shapes patient care.

How a Physician With Crohn's Disease Approaches IBD Care

Symptoms and inflammation do not always move together in inflammatory bowel disease (IBD), and for Jordan Axelrad, MD, MPH, co-director of NYU Langone's Inflammatory Bowel Disease Center, that disconnect shapes nearly every conversation he has with patients who call in feeling unwell.

"Symptoms do not always correlate with objective inflammatory activity," Axelrad told HCPLive in an interview.

Check Out More of Our Interview With Axelrad 

Patients often reach out reporting acute symptoms and asking for prednisone, assuming a flare is underway. Axelrad said it's important for patients to understand that a symptom flare doesn't always line up with actual disease activity, which is exactly why an objective check is needed before assuming the worst.

"That may require laboratories, biomarkers including C-reactive protein and fecal calprotectin, it may require endoscopy to more objectively assess the status of the mucosa, and in patients with Crohn's disease, may often require cross-sectional radiography or intestinal ultrasound," he said. The specific combination depends on the patient, but the goal is the same across the board: replace a subjective symptom report with objective evidence before deciding how to act on it.

"Having these objective markers of inflammatory activity help us differentiate symptom exacerbation or an infectious etiology from flare of underlying IBD," Axelrad said. Those distinctions, he noted, are managed very differently.

"I have the treat-to-target conversation with all of my patients so that my patients and I are on exactly the same page when we're discussing therapy initiation," Axelrad said. That means setting expectations up front: symptomatic improvement within a couple of weeks to months, biomarker improvement on a similar timeline, and longer-term endoscopic, or in Crohn's disease sometimes radiographic, improvement as the ultimate target.

"Generally we want to see meaningful improvements in endoscopic response within 6 months to 1 year, and we're adjusting treatment based on treat-to-target if we're not achieving those important goals," he said.

"There may be instances where patients have no response to an individual therapy, in which case we may switch to a completely different mechanism, whereas many patients may have partial response and we may work towards optimizing that therapy to meet our treat-to-target goals," Axelrad said. That variability is precisely why the objective checkpoints matter: without them, a partial responder and a non-responder can look identical from the symptom picture alone.

Counseling Patients as a Physician Who Has Crohn's Disease

"I think patients find comfort in recognizing that I'm someone who's also used the medications that I'm talking about with patients," Axelrad said. He lives with Crohn's disease himself, and said that for a disease that often affects younger people, moving to a long-term infusion or injectable therapy is a major modification to a patient's life. That shared experience shapes what he listens for in a visit, since patients rarely lead with questions about how fast a drug works.

"Patients oftentimes don't come to the office saying, how quickly can I feel better? They're usually much more concerned about the side effect profile and the long-term interruption of these medications in their lives," he said.

Having sat on the other side of that conversation himself, Axelrad said he's able to meet those concerns directly rather than defaulting to reassurances about efficacy alone.

"Having that personal experience I think really gives patients calm and more confidence in making these decisions together as far as medication selection," Axelrad said.

Editor’s Note: Axelrad reports relevant disclosures with AbbVie, Abivax, Adiso, BioFire Diagnostics, bioMérieux, Bristol Myers Squibb, and others. 

National Institute of Diabetes and Digestive and Kidney Diseases. Crohn's disease. NIDDK. Reviewed July 2024. Accessed August 18, 2026. 

https://www.niddk.nih.gov/health-information/digestive-diseases/crohns-disease

Crohn's & Colitis Foundation. What are the early indicators of Crohn's disease and ulcerative colitis, and how are these two diseases different from each other? Crohn's & Colitis Foundation. Accessed August 18, 2026. 

https://www.crohnscolitisfoundation.org/blog/ulcerative-colitis-vs-crohns-disease-what-are-the-early-signs-and-how-are-they-diagnosed

Videos

A gastroenterologist explains why IBD symptoms don't always signal a flare, the biomarkers used to confirm inflammation, and counseling patients through Crohn's disease.

With a growing number of mechanisms of action now available for Crohn's disease and 

, choosing a first-line therapy and sequencing treatment after failure has become a more layered decision. For Jordan Axelrad, MD, MPH, co-director of NYU Langone's Inflammatory Bowel Disease Center, that decision starts with disease activity and severity, and ends with the patient at the table.

"Once we sort of meet in the middle of what's important to the patient and how severe and active their disease is, which also influences drug selection, then we make a decision together," Axelrad told HCPLive in an interview.

Assessing Activity, Severity, and Patient Preference First

Every new patient visit begins with 2 assessments, Axelrad said: disease activity, a snapshot of what is happening right now, and disease severity, meaning the patient's risk of disease progression and long-term prognosis. The latter is especially relevant in Crohn's disease, though it factors into UC management as well.

Alongside that clinical picture, Axelrad brings the patient into the decision directly, gauging what matters most to them: whether they can accommodate an infusion, whether they are willing to self-inject, or whether they want to stay on an oral medication. Drug selection ultimately reflects where disease severity and patient preference meet.

That same framework carries forward once a first therapy fails. After confirming failure objectively, through biomarkers or endoscopy rather than symptoms alone, Axelrad typically moves to therapies with evidence in the second or third-line setting, primarily anti-TNF agents and JAK inhibitors today. Disease activity and severity remain the deciding factors in what a patient needs next.

Treat-to-Target and Confirming True Remission

Underlying all of this is a treat-to-target approach that Axelrad discusses with every patient starting therapy, so that expectations are aligned from day one. "I'm having that conversation with patients so they can understand exactly the expectations of when they may start feeling better," Axelrad said. Patients are told what to expect and when: symptomatic improvement within a couple of weeks to months, biomarker improvement on a similar timeline, and longer-term endoscopic, or in Crohn's disease sometimes radiographic, improvement as the ultimate target.

Meaningful endoscopic response is generally expected within 6 months to 1 year, and treatment is adjusted when that goal is not met. Response is not uniform. Some patients show no benefit from a given therapy and require a switch to a different mechanism entirely, while others have a partial response that can be optimized within the same drug to reach treat-to-target goals.

That framework also shapes how Axelrad evaluates new therapies as they reach the market. Despite the expanding treatment landscape, he pointed to a persistent, substantial amount of unmet need in IBD. "A meaningful disease remission as far as endoscopic remission is difficult to achieve with our current therapeutic arsenal," Axelrad said, noting that certain Crohn's disease subtypes, such as fistulizing and stricturing disease, respond far less well to existing therapies than others.

When a new drug comes to market, Axelrad said the central question is where its value lies. "Is it a route of administration? Is it a safety? Is it efficacy? Does it work in unique subtypes? Where is that value?" he said. Therapies that work well in patients who have already failed other treatments are especially valuable additions, since that population carries the greatest unmet need. Even with continued approvals, Axelrad said the field is still searching for new therapies, or combinations of therapies, that move more patients toward meaningful, lasting disease control.

Jordan Axelrad, MD, MPH, discusses first-line IBD therapy selection, sequencing after failure, treat-to-target monitoring, and evaluating new agents

Iron Deficiency Anemia in Gastroenterology: Managing Underlying Causes and Tackling Treatment Challenges 

This presentation on managing iron deficiency anemia (IDA) in gastroenterology discusses common causes, treatment options, and evolving therapies. It emphasizes the importance of understanding the underlying causes and selecting appropriate treatments for patients with IDA, particularly those with gastrointestinal conditions.

 In clinical practice, iron deficiency often results from malabsorption, chronic blood loss, and dietary issues. Identifying the root cause of the deficiency is crucial for effective management.

 Intravenous (IV) iron is beneficial for a wide range of patients, especially when oral iron is poorly tolerated, as in inflammatory bowel disease. Recent advancements have improved tolerance to IV iron, making it a viable option for many patients. Oral iron regimens, such as administering iron every other day, may be better tolerated for some individuals.

 It is important to differentiate between iron deficiency and anemia through proper screening, including ferritin and iron saturation tests. Gastrointestinal issues can complicate the use of oral iron.

Iron deficiency in gastric bypass patients:

 Patients who have undergone gastric bypass surgery are at higher risk for iron deficiency. These patients may require more tailored approaches, including IV iron therapy, depending on their specific needs.

 The safety profiles of different IV iron formulations vary. Misconceptions about IV iron, such as concerns about safety, need to be addressed. Clinicians should be familiar with the various formulations and their associated risks.

 Choosing the appropriate treatment for each patient depends on their individual condition and tolerance. Clinicians should understand what to expect from different therapies and when to make treatment adjustments.

 Adverse reactions to IV iron infusions, though rare, can occur. Physicians should be prepared to manage these reactions promptly if they arise.

 Ferric carboxymaltose is an emerging IV iron formulation that has shown lower adverse reactions in some cases. However, it carries a risk of hypophosphatemia, and phosphate levels should be monitored. This formulation may not be suitable for all patients.

 Experts from both hematology and gastroenterology provide final thoughts, offering pearls of wisdom for nonhematologists on managing IDA, highlighting the importance of personalized treatment strategies.

In summary, successful management of IDA requires a comprehensive understanding of the causes, treatment options, and individual patient needs. Regular monitoring and the careful selection of iron therapies, including IV options, are essential for optimal patient care.

Panelists discuss how understanding the causes of iron deficiency anemia, selecting appropriate treatments such as intravenous iron, and tailoring therapies to individual patient needs are critical for effective management, particularly in patients with gastrointestinal conditions.